P1.218. Early Results of Shifting From CROSS to FLOT for Neoadjuvant Therapy Before Esophagectomy

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications There has been a shift from CROSS (C) neoadjuvant chemoradiation to FLOT (F) perioperative chemotherapy for esophageal and gastro-esophageal junction adenocarcinomas. We hypothesized that the shift to FLOT would be associated with higher pathologic complete response rates and potentially lower rates of post-operative anastomotic leak. Data for patients receiving esophagectomy for esophageal cancer from a single high-volume center were prospectively collected from Jan 2019 to Dec 2025. Patients receiving neoadjuvant care were treated primarily at non-affiliated community cancer centers in the region. Patients received a variety of surgical approaches with cervical and intra-thoracic anastomoses. Demographic data, neoadjuvant treatments, perioperative outcomes, and pathologic data related to surgery were compared using chi-squared and t-tests. 441patients received an esophagectomy, of which 392 had adenocarcinomas, with 260 (66%) receiving CROSS, 61 (16%) no prior treatment, 33 (8%) FLOT based therapy (5 with immunotherapy), 12 (3%) received FOLFOX based treatments and 26 (7%) had incomplete records. There was a trend towards C patients being older (65 +/- 9 yrs vs 62 +/- 9 hrs, p=0.07). There were similar rates of interrupted neoadjuvant therapy (22% C vs 15% F, p=NS). PCR (23% C vs 21% F, p=0.77) and positive margin rates (3.5% C vs 0% F, p=0.28)) were similar between groups. Of note, 36 patients with squamous cell cancer received CROSS with 19 (53%) having a PCR (Figure). Complication rates (71% C vs 58% F, p=NS), leak rates (27% C and 15% F, p=0.13), and length of stay (11+/- 8 dys C vs 10 +/-8 dys F, p=NS) were also statistically similar. The adoption of FLOT based therapy prior to esophagectomy appears to have similar results in pathologic CR rates compared to CROSS for patients with esophageal adenocarcinomas. Complication rates, including anastomotic leak appear similar, also with similar postoperative recovery periods. In this cohort the adoption of perioperative FLOT did not result in increased adverse perioperative outcomes.